HomeMy WebLinkAboutTCC CORPORATION - INSURANCE CERTIFICATE 2023-2024�►�� 0� CERTlFICATE OF L1AB�LITY INSURANCE � �20 2oz3
THIS CERTIFICATE IS ISSUED AS A MATTER O� INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER'iIFICATE HOLDER. THIS
CERTIF[CATE �OES NOT AFFIRMATIVE�.Y OR NEGATIVELY AMEND, EXTEND OR AL7ER THE COVERAGE AFFORDE� 8Y THE POLICIES
BELOW. TFlfS CERTIFICATE OF INSURANCE DQES NOT CONSTITUTEA CONTRACT BETWEEN THH ISSUING lNSUREl2(5}, AUTH�RIZED
REPRESENTATIVE QR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSUR�D, the policy(fes) must ae endo�sed. If SUBROGATION IS WAIVEd, suhject to
the terms and conditions of the policy, certain poftcfes may requirs an endorsement. A statement on th�s certificate does not confer rfghts to the
certiffcate holder in lieu of sucf� endo�sement[sj.
PRODIJCER NAME: �R�@ MCR@]/ROZC�S
Ewing-Leavitt Insuranqe Agency, Inc. PHONe .(g70)679-7394 �C No: ;�66]�25-6�80
4090 Clydesdale Park�vay a o� R�fss:renee-mcreynalds@leavitt.com
', SLIl�� 101 INSURER 3 AFFOROING COYERAGE NAIC M
Loveland CO 80538 iNsuReaa:5elective Insurance Co an of America 012572
�NsurtEo iNSUReR e: Pinnacol Assurance 4119Q
TCC Corporation wsuReRc:American Zurich Insurance Co 40142
6D9 Gryfalcon Ct INSURERD:
UEit. D INSURERE:
windaor CO 80550 INSURERF:
COVERAGES CERTIFICATE NUMBER:23-24 update RHVI510N NUMBER:
TH1515 TO CERTIFY THRTTHE POLICIES OF iNSURANCE LiSTED BEL[3W HRVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH� POLICY PERIOD
INDICATED. NOTIM�HSTANDING ANY REQUIREMEiVT, TERM OR CONDITION C:F RNY C:ONTRACT OR O7H+ R DdCUMENT VNTH RESPECT TO WHICH THIS
CERTIFICAiE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE PO�ICfES �ESCRIBED HEREiN IS Sl18JECT TO ALL THE TERMS,
EXCLUSIdNSAND CONDITIONS OF SUCH POL�CI�S. LIMITS SH01NN MAY HAVE BEEM REDUCED BY PAI� CLAlMS.
�LTR �E OF INSUFiANCE AO�L SUBR pOLfCY NUMBER MMlDDY1YYYY MMlD�lYYYY LIMITS
X COMMERCIAL GENERAL LIABILiTY F.4CH OCCURRENCE $ 1, oaa, D00
A 4LA�M5-MA;� Q OC{;'J� PREMISES Ea pcqartence a soo, 000
x Blkt Addl Inaureda X s2325696 �/1/2a23 5/1/2026 MED EXP (My one person) S 15,OOQ
X B1lct Waivor Subroqation PERSONAL BApVINJURY S 1,000,000
GEN'LAGGREGATELIMITAPPLIESPER GENERALAGGREGATE S 3,OOO,Q00
POLICY a PRO- � LOC PRODUCTS-COMPlOPAGG S 3,OD0,000
JECT
OTHER: S
AUTOMOBILE LWBILITY COM8INEQSINGLE LlM1T E 1, 000, 000
Ea acddent
A X ANY�Ur:7 BODILY INJIJRY (Per personE t
ALL DWNED SCHEOULE� g2325C40 5/1/2023 5/1/2024 BODI�Y INJURY (Per accidenly S
AUTOS AUTOS X
X % NON-0WNEU PPReQaE�R�T�Y OAMAGE s
HIREDAUTOS AUTOS
X 91ktAddllnsurods X BIk1V4D5 S
X UMBRELLALIAB X pCCUR Follor Foim EACH OCCURRENCE S 2 000 000
A E%CESSLIAB CLAIMS-MADE AGGREGATE S 2 000,000
DED RETENTION 3 52325<90 5/1/2023 5/1/202C s
WORKERS COMPENSATION Snel 6lanket Naiver oE X OTH-
AND EMPLpYERS' LIABILITY Y � N TAT TE R
ANYPROPRIEt'OWPARTNERlExECUTIVE Subzoqation E.L EACH ACCIDENT S 500 000
OFFICERfMEMBEREXCLUDED? ❑ N!A
g (MandatorylnNH) <D21079 7/1/2023 T/1/202< E.4 DISEASE EAEMPL�YEE S 500 000
If yes, desenbe untler
OESCRIPTION OF OPERATIONS belaw E.l. DISEASE - POtICY L1MIT S 500 000
C Suilderca Aiek BRT3861347 5/1/2021 contiavous S3,WO,OOOanyoneavuqum 51000 deductible
A Contractora Equipment 52325�90 5/1/2023 5/1/2024 LeayedrRentatlEqu�p $250,000 limit
�ESCRIPTION OF OPERA710N5! LOCATIONS 1 VEHICLES �ACORD 101, Additional Ramarks Schedule, mpy be alSached if more spacr is raqulrad}
Re: 9718- Chiidcare Center Renovation- Northside Aztlan Center
Certi.ficate holder is named as additional insured. The insurance evidenced by the certificate will not
reduce coverage or limits and will not be cancelled except after 30 daya written natice has been isaued
to certificate holder, 10 day notice will apply in the event af non-payment of premium,
GERTiFIGATE HOL�ER
City of Fort Collins
Building & Zoning �ept
P 0 Box 580
Fort coiiins, co aasz�
C�liC�l���l_tiL�lil
SHOULD ANY OF THE ABOVE �ESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPfRATION DATE THEREOF, NpTICE WILL BE UELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORI2ED REPRESEHTq71VE
McAeynolds:� iti�:��'"���__
�.�°�`�Pt .�d"°f�aJ
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101 j The ACORD name and logo are registered marks of ACORD
INS025 (zo+aoa�
,4Co � CERTIFICATE OF LIABILITY INSURANCE °"'�`"�°°'""Y"'
��" 6/20/2023
TH1S CERTIFICATE 15 ISSUED AS A MATTSR OF INFORMATIDN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TFflS
CERTIFICATE DQES NOT AFFIRMA7IVELY OR NEGATIVELY AMENfl, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. 7HIS CERTIFICATE OF INSlIRANCE dOES NOT CONSTITUTE A CpNTRACT BETWEEN THE ISSUING iNSURER(Sj, Ak1THQRIZED
REPRESENTATIVE OR PRODUCER, AND THE CE#iTIFICATE HQLDER.
IMPORTANT: If the certiflcate ho[der is an ADDITIONAL INSURED, the policy�les) must be endvrsecf. if 5l1BROGATION IS WAIVED, sub)ect to
the terms and conditlons of the polEcy, certafn policies may require an endorsement. A statement on this certificate does not confer rights to the
certiflcate holder in lieu of such endorsement[s).
PRODUCER NaME• Renee McReynolds
Ewing-Lesvitt Iasvrance Agency, Inc. PHONE ,(g70} 679-7344 �C Np: 1664a��5-51ec
4p90 Clydesdale Parkway E'�'�� renee-mcreynolds@leavitt.aom
AooRess:
Sl7�t@ 141 INSURERS AFFORUINGCOYERAGE NAICp
Loveland CO 80538 INSURERA:Se1BCtifY� insurance Co an pf America 012572
� iHsuReo iNsurtert e: 2innacol Assurance 9119p
I�TCC Corporatian �NSUREreC:American Zurich Insurance Co 46142
� 609 Gryfalcon Ct INSURERU:
Unit D Ik3URER E :
Windaor CO 8055p IMSIIRERF:
COVERAGES CERTIFICATE NUMBER:23-24 update REVI510N NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEQ BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR tHE POLICY PERIOD
INDICATE� N071MTH5TANDING ANY REQUIR@M�NT, TERM OR CONDITION OFAMY CONTRACT pR OTHER DOCl1MENT VNTH RESPEC7 70 WHICH THIS
CERTIFICATE NfAY BE �SSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBE� HEREIN IS SUBJEC7 TO ALLTHE TERMS,
EXCLUSIONSAND COMDITIONS OF SUCF+ POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIp CLAIMS.
�TR TYPEQFINSURANCE A�p�sUBR ppLICYNUMBER MMQI�D��lYYYY MMlDDIYYYY I.IMRS
X COMMERCIAL GENERAL LiA61LITY EACH OCCURRENCE � f, 000 , 000
A GL41MS-MADE X❑ OCCUR PREMISES Ea oceurcence S 50U, 000
X Blkt Addl In�ureda 32325190 5/1/2023 5/1/2026 MED El(P (My one person� S 15,000
x Blkt Waiver Su6rogation PERSONAI 8 A�Y INJURY 5 1, ap0 , OOU
GEN'�AGGREGATEUMi7nAPLIESPER GENERALAGGREGA7E S 3,000,000
POLICY � P��� � LOC PRODUCTS-GOMP7OPAGG 5 3,000,000
x JECT
OTHER- S
AU70MOBILE LIASILITY GOMBINED SINGLE LIMIT S 1, 000 , 000
Ea acddent
A X ANYAUTO BpDILYINJURY(Perperson) S
ALL OWNED SCHEDULED g2325<90 5/l/2023 5/1/2024 BOOILY INJURY (Aer acddenlf S
AUTOS AUTOS
NOIY�OWNED PROPERTYpAMAGE S
x HIREOAUTOS X AUTOS Peracdtlent
X BfktAdtll InsurcAs X Blki WOS g
X UMBRELUiLIAB ]f pCCUR Fo12or Fo=m E,4CH OGf_URRENCE S 2 000 000
A ��Eg$ ��B CLAIMS-MARE nGGREGATE S 2, 000,009
OED RE7ENTION S 32325�90 5/1/2023 S/1/2024 y
WORKERS COMPENSATION incl elanket Waivar of X FAT T ERH
AND EMPLOYERS' I.iA81LITY Y 1 N
ANY PROPRIETORlPARTNERlEICECUTIVE ❑ N!A Su6rogation El. EACH A^CIOEN7 S 500 000
B OFRCERlMEMBER EXCLl1DE0? �
(MandalaryinNH) 0021079 7/1/2423 7/]12024 E.L.DISEASE-EAEMPLOYE� S 500 000
II yes, dascn6e unde�
OESCRIPTION OF OP@RATIONS 6elow E-L OISEASE - POLICY LIMIT 5 500 000
i.` Builders Ri�k BR73861367 5/1/2021 eontinuoua f3,000.OW pnyona sWAuro $lOQO deduCtibla
A Contractors Equipmant 52325C40 5/1/2023 5/1/202A 4ea�earRentetlEquip $250,000 limit
�ESCRIpTION OF OPERATIONS f LOCATlONS! YEHIClE3 (ACORU 101, Addflfonal Remarks Seheduls, may bs attachsd H mon spaca In required)
Certificate holder is named as additional insured.
GERTIFIGATE MQLDER
City of E'ort Collins
8uilding 6 2oning Dept
P O eox 580
Fort Collins, CO 80522
GANGELLATION
5fi0ULD ANY OF THE ABpVE pESCRIBEU POLICIES BE CANCELLED BEFORE
THE FJCPIRATION DATE THERflOF, NOTICE WILL 8E DELIVEREO IN
ACCORDANCE WITN THE PQLIGY pROVISIONS.
AUTFiOR12E� REPRESENTATIYE
McReynolds/RESTEI
�,°�`r�h�1�.�xeeRaJ
O 1988-2014 ACORD CO
ACORD 25 (201410'E� The ACORD name and logo are registered marks of ACORD
INS025 �2oiaoi�
A� o� CERTfFICATE OF LIABILITY INSURANCE D 6/2D/2o�
THIS CERTIFICATE IS 15SUED AS A MATFER OF INFORMATION OMLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFtRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFQRDE� 8Y THE POLICIES
BELOW. THI5 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW£EIV THE ISSUING INSURER(5j, AUTHORIZE�
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy[ies) must be endorsed. If SUBROGATION IS WAIVED, subJect to
the terms and cond�tions of the policy, certain poltcies may require an endorsement. A statement on this certiiicats doss npt conter rights tv the
certificate holder in lieu of such endorsement(s�.
PRODUCER NAME �n�@ MCR@]/RO1C�S
Ewing-Leavitt Insurance Agency, Inc. PHo"e .(g76� 679-7344 �C N0: (666��25-6180
4090 Clydasdale Parkxay aooRess:renee-mcreynolds@leavitt.com
SL11t.B LO1 INSURER S AFFOR�ING COYERAGE NAIG N
Loveland CO 80538 iNsurtean:Selective insurance Co an of America 012572
INSURE� INSURER B: P1II7laC01 Assu=ance 41190
TCC Corporation iNsuaEac:American Zurich Insurance Co 40142
609 Gryfalcon Ct iwsuReao:
Unit D INSURERE:
W1Ad80= CO 80550 INSURERF:
COVERAGES CERTIFICATE NUM8ER:23-24 update REVISiQN NUMBER:
TFiIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEQ ABOVE FOR THE AdLICY PERIOD
INDICATED. NONNTHSTAIVDING RNY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT �R OtFiER DOCUMENT 1M1I�TH RESPECT TO WHICH THIS
CERTIFECATE MAY BE ISSUED OR MAY PERTAIM, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIiE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH PQLIGIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA1D CLAIMS.
�LTR 1YPE OF INSURANCE �DL SUBR pOLICY NUMBER MMlDDYIYYYY MMID�YIYYYY L[MITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENGE S 1, 000 , 000
A CLAIMS-MA�E aOCCUR PREMI E Eaoccurtenca S 500,000
X Blkt Addl Inaureda X 32325C98 5/1/2Q23 5/1/2024 MED EXP (Any ona person) S 15 , OOQ
X Slkt Waiver Subroqation PERSONAL SADVINJURY S 1,000,000
GEN'LAGGREGATELiMITAPPLIESP@R GENERALAGGREGATE S 3,000,000
POLICY � PRQ � LOC PRODUCTS - COMAlOP AGG 3 3, 000 , 000
JEC7
OTHER. S
AUTOMOBILE LiABILITY COMBINEQ SINGLE L4MI7
Eaatadem 5 1,000,000
A X ANY AUT4 BOORY INJURY (Per person� S
ALL ONMED SCHEDULED X 52325494 5/1/2023 5/1/2024 E33DfLY INJl1RY (Per acqdenq 5
AUTOS AUTOS �aOPERTY DAMAGE
N07V-01MNEd Per attidenl b
x HIRE�AUTOS x AUipS
X B{klAddllnaureds R BIk1YW5 S
X UMBRELIALIAB X pCCUR Follow Focm EACH OCCURRENCE S 2 000 ODO
A ElfCE55 LIAB CLAIMS-MA�E AGGREGATE S 2, 000 , D00
DE� RETENiION $ 32325490 5/1/2023 5/1/2p24 S
WORK@RS COMPENSATION inel Blanket Msiver oE x TH-
AND EMPLOYERS' LIA8141TY Y! N STAT TE ER
ANY PROPRIETOR7PAR7NERIEX�GUTiVE SubrogptiOn F.� EACH ACCIDENi S S0� , 000
OFFICERlMEMBEREXCLUOED7 ❑ H!A
B (MandataryfnNH) 4021079 7/1/2023 7/1/2p29 E.l pISEASE-EAEMPLOYEE S 500 000
IF yes, desvi6a under
�ESCRIPTION OF OAERATIONS belaw �.. �ISEASE - POLICY LIMIT S 500 000
C Buildera Riak 8R738623<T 5/1/2021 continuoua 53.00O,OOaanyoneawaure 51000 deductibla
A Contractora Equipment 52325C90 5/1/2023 5/1/2021 �easedmen�adEqu�p $250,000 limit
OESCRIPTION OF OPERATIONS f LOCAZIONS ! VEHICLES jACORU 100, Addidonat Ramarks Schedula, may 6e attached if mpre spacr i� requErad}
Re: City Hall Council Areas Renovation, 300 LaPorta Ave, Fort Collina, CO;
Certificate holder is named as additional insured. The insurance evidenced by the certificate will not
reduce coverage or limita and will not be cancelled except after 30 days written notice has been issued
to certificate holder, 10 day notice will apply in the event of non-payment of premium.
GERTIFIGATE MOL�ER
City of Fort Collins
Buildinq � Zoning Dept
P 0 Box 580
Fort Collias, CO 80522
CANGELLATIp{V
SHOULD ANY OF THE ABOVE DESCRIBEU POLICIES 6E CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEI.IVERED IN
ACCpI2DANGE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
McReynolds/RESTEI
�`y?t °�BnJ
CORPQRATIpN. All riahts �
ACORD 25 (2014101} The ACORD name and logo are registered marks of ACORD
INS025 {zotao>>